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Genetics and Health Care Reform. The Long View From…a novice non-crystal baller John J. Mulvihill, Heartland (Thanks to ACMG President Bruce Korf). Disruptive Innovations Over Time. Computers: Abacus; IBM/DEC main frame; HP calculator; PC/Mac; massively parallel processors

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Genetics and Health Care Reform


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genetics and health care reform
Genetics and Health Care Reform

The Long View

From…a novice non-crystal baller

John J. Mulvihill, Heartland

(Thanks to ACMG President Bruce Korf)

disruptive innovations over time
Disruptive Innovations Over Time

Computers: Abacus; IBM/DEC main frame; HP calculator; PC/Mac; massively parallel processors

Communication: Smoke signals; pony express; telegraph; wired telephone; cellular telephone; Internet

Education: Tutor; University; Community College; On-line

Access by wealthy to access by all

disruptive innovations elements
Disruptive Innovations: Elements

1. Technology enabler

2. Business model

3. Valued network

disruptive innovations 1
Disruptive Innovations 1

Technology Enabler

Intuitive medicine What’s the diagnosis?

Past: Infectious disease; Future: All diseases

Empirical medicine What to do? How to fix?

Past: Trial-and-error; Future: Mechanism based

Precision medicine Exact diagnosis and therapy

Past: Strep throat; Future: Genetic diagnosis and Rx

disruptive innovations 2
Disruptive Innovations 2

Business model

Solution Shop Hospital/clinic Mayo/Cleveland

Fee-for-service; complex; no guarantee

Value-added process Hospital/clinic Heart Hospital

Eye Institute

MinuteClinic

Fix it; fee-for-output; simple; guaranteed

disruptive innovations 21
Disruptive Innovations 2

*But, Crossing the Quality Chasm;

To Err is Human; cost

Business model

Solution Shop Hospital/clinic* Mayo/Cleveland

Fee for service; complex; no guarantee

Value-added process Hospital/clinic* Heart Hospital

Eye Institute

MinuteClinic

Fix it; fee-for-output

disruptive innovations 3
Disruptive Innovations 3

Value Network

Insurance Mutual help Health Club; WebMD

Membership fee

Profit for wellness

disruptive innovations
Disruptive Innovations

Gene Diagnostics

Gene therapy, pharmacogenomics

Business model

Solution Shop Hospital/clinic* Mayo/Cleveland

Fee for service; complex; no guarantee

Value-added process Hospital/clinic* Heart Hospital

Eye Institute

MinuteClinic

Fix it; fee for output

disruptive innovations1
Disruptive Innovations

Anticipatory guidance; EMR;

Genetic Alliance; Social networking

Value Network

Insurance Mutual help Health Club; WebMD

Membership fee

Profit for wellness

slide18

Other thoughts*

Forced productivity gains

Cadillac coverage

Simplified forms

Electronic medical records

Reform of delivery system

Independent commission

Managed competition

A public plan/option

Comparing treatments

Negotiating drug prices

Malpractice reform

*New York Times

November 15, 2009

Editorial, p 9

slide19

Other thoughts*

Forced productivity gains

Cadillac coverage

Simplified forms

Electronic medical records

Reform of delivery system

Independent commission

Managed competition

A public plan/option

Comparing treatments

Negotiating drug prices

Malpractice reform

*New York Times

November 15, 2009

Editorial, p 9

slide20

Questions?

Comments?